In today’s increasingly mobile and interconnected world, with about 258 million international and 760 million internal migrants^[1], migration must be recognized as a social determinant of health, impacting upon every individual’s vulnerability and well-being. Migration also profoundly affects the lives of families back home, as well as people in communities of origin, transit and destination world-wide.

Despite well-established diagnosis and treatment regimens, TB remains a public health burden in many parts of the world and a leading infectious killer, with an estimated 10 million new cases and approximately 1.3 million deaths in 2017[2], disproportionately affecting poor and marginalized populations, such as migrants. TB prevention and control efforts often do not address the specific vulnerabilities of migrants, which leads to delayed diagnosis and/or discontinued treatment.

The way in which many migrants travel, live and work, can carry risks for their physical and mental well-being.   Many work in dangerous, difficult and demeaning jobs, and live in isolation and sub-standard housing. Others may be detained in over-crowded detention facilities or live in camps as refugees or internally displaced persons. Migrants are thus among the vulnerable groups that face a particularly high level of TB risk factors.

In addition, migrants face barriers to accessing health services due to language and cultural difference, and administrative hurdles. Migrants are often excluded from social protection in health and are invisible to Universal Health Coverage (UHC) programmes. As a result, many migrants pay out-of-pocket to get the health services they need, which may result in catastrophic health expenditure, delayed and substandard care.

It’s time for inclusion of migrants!  Worldwide, in 2018, IOM conducted more than 376,800 pre-departure health assessments for migrants and refugees and detected 584 active cases of TB, which translates to a TB detection rate of 155 per 100,000 health assessments. Active TB cases were either confirmed by sputum culture or diagnosed based on clinical and radiological findings. IOM works in collaboration with National TB Programs and is committed to accelerate the end of TB through the strengthening of migrant-sensitive health systems, able to assess and focus on the specific vulnerabilities and conditions of the migrant population. (see video with story from Jordan)   

It's Time to set ambitious goals for treatment success, which is possible based on the success story from IOM’s Migration Health Assessment Centre in Nairobi, Kenya, where DOT clinics surpassed targets with comprehensive care, by including active reach-out to patients and nutritional support, ensuring that neither patients nor their households suffer catastrophic costs due to TB, a key element in achieving the target 3.8 of the Sustainable development goals (SDGs).

Successful treatment of TB hinges on DOT and patient-centered, migration-sensitive care, where an individual’s specific health needs, migration related vulnerabilities and desired health outcomes are taken into consideration. Treatment of persons testing positive is a core part of IOM’s health assessments for migrants, including refugees prior to resettlement. From 2010 to 2016, IOM’s Migration Health Assessment Centre in Kenya diagnosed 426 cases of active TB, treating 363 of them at IOM Kenya’s TB DOT clinics, while the others were referred for treatment. IOM Kenya’s TB DOT clinics sustained high treatment success rates over this period, ranging from 90% to 100%.

It’s time to be accountable to the TB commitments. IOM’s experience has shown that failing to address the health of migrants has severe consequences for the well-being of millions of migrants and communities of origin, transit and destination. Migrants urgently need to be included at global, national and local prevention and control strategies to end the TB epidemic, in line with the objectives of the Global Compact for Safe, Orderly and Regular Migration and the Resolution 70.15 of the World Health Assembly on Promoting the health of refugees and migrants (2017).

Moreover, the End TB Strategy, the Moscow Declaration and the UN High Level Meeting Declaration “United to End Tuberculosis” afford a tremendous opportunity to ensure and commit at the highest level to not leave migrants behind and promote cross-border collaboration amongst countries towards reducing TB and HIV burden. Jacqueline Weekers, Director of IOM’s Migration Health Division said: “Ending TB means addressing the intrinsic linkages between population mobility and tuberculosis as well as acknowledging that UHC is only real if high risks groups are accounted for”.